Social media applications within the NHS: role and
impact of organisational culture, information
governance, and communications policy
Catherine Ebenezer
PhD student, Information School, University of Sheffield
C&L AHPR Event
21st October 2015
Supervisors: Professor Peter Bath, Dr Stephen Pinfield
1
2
We trust our staff with patients’ lives, so why don’t
we trust them with social media?
NHS Employers (2013, p. 9)
Shouldn’t we be managing the risks more
effectively in order to allow learners the freedom to
use IT resources to better effect?
Prince et al. (2010, p. 437)
3
Overview
• Introduction and background
• Definitions
• Content types
• Web application blocking: earlier findings
• Research questions and issues
• Methodology and methods
• Findings
• Availability
• Respondent perceptions
• Risks
• Benefits
• General findings
• Questions
Introduction and background
• LIS Manager in mental health NHS FT 2008-2012
• Variety of technological barriers / hindrances to
information seeking, teaching and learning, clinical and
management decision-making
– ascribed variously to:
• Information governance/ information security
• IT infrastructure policies and practices
• Communications policy
• Blocking of ‘legitimate’ websites
• Obstacles to use of particular content types and
applications
• Social media / Web 2.0 a particular problem
• Implications?
4
5
Web 2.0 and social media - definitions
• Web 2.0
• Difficult to define – not just technologies – an approach –
about values
• “A network platform through which end users interact with each
other to generate and share information over the web”
(Singh et al., 2014)
• “A collection of web-based technologies … where users
actively participate in content creation and editing through open
collaboration between members of communities of practice”
(McGee & Begg, 2008)
• Inherently egalitarian and unstructured – cf. ‘traditional’ IT
• Require AJAX, Adobe Flash, RSS
• e.g. mashups, start pages, folksonomies, podcasting
6
Web 2.0 and social media - definitions
• Social media
• Subset of Web 2.0 – applications allow the creation and exchange of
user generated content (Kaplan & Haenlein 2010)
• Rapidly developing field
• “[involve] the explicit modeling of connections between people,
forming a complex network of relations, which in turn enables and
facilitates collaboration and collaborative filtering processes”
• Enable users to see what other connected users are doing
• Enable automated selection of “relevant” information
• Enable reputation and trust management, accountability and quality control
• Foster “viral” dissemination of information and applications
• Provide “social” incentives to enter, update, and manage
personal information (Eysenbach, 2008)
Web application blocking
Impacts
9
Online databases
*’core content’
or locally
purchased
11
E-books*
25
E-journals*
35
Webmail
69
Discussion forums
51
Communication tools
57
Wikis and blogs
77
Social networking applications
0
10
20
30
40
50
60
70
% of trusts
SHALL IT subgroup survey of NHS librarians (2008))
7
80
90
8
Research questions / issues
• The nature and extent of restrictions on access to such applications
within NHS organisations arising from organisational policies
• Their impacts on professional information seeking and sharing, and
working practices in general
• The attitudes, professional norms, presuppositions and practices
which bear on how social media policy is implemented within NHS
trusts, in relation to overall organisational strategies
• Rationales for restrictions
• Differing stakeholder perspectives involved
• Attitudes to / assumptions about (information governance, information
security) risks and possible benefits
• Level / nature of access to and use of social media for
professional purposes by NHS staff
Part of a wider study of access to information for learning and teaching
Methodology and methods
Exploratory case study
• Unit(s) of analysis
• One or more NHS trusts of different types (DGH + community
services, MH + community services, teaching hospital)
• Methods
• Semi-structured interviews with key informants (10+ per trust)
• selected via purposive / snowball sampling
• representing a variety of perspectives:
• Clinician education and staff development
•
•
•
•
•
•
Library and information
Communications
Information governance
IT management, esp. network security and PC support
Human resources
Workforce development
9
Methodology and methods
Exploratory case study
• Methods (cont’d)
• Interviews with other key informants: NHS Evidence, medical
school e-learning lead, secure web gateway vendor
• Gained additional perspectives
• Documentary analysis – selective / ad hoc
• Background
• Policies and strategies: IT, LIS, workforce development, information
•
•
•
•
governance, Internet AUP
Codes and standards
Reports and reviews
Statements of values
Security device documentation
• Thematic analysis using NVivo
10
11
Availability: Web 2.0
Podcasts
T1-DGH
Trust starting to
use podcasting on
intranet
Availability of
external podcasts?
T3-MH
Sometimes unable to
download from web /
appear blocked owing to
inadequate bandwidth –
but podcast content
planned for new trust
intranet
Podcasts produced
internally for training
purposes
and used for PG medical
education – but clinical
tutor mentioned one being
blocked
File storage and
sharing
applications
Time quota set for
use
Web conferencing
Skype blocked
T4-TH
Podcasts created
by speech and
language therapists
for ENT training
Respondents
unclear about
availability of
external podcasts
Not mentioned
Dropbox blocked
Skype blocked
Google Docs
available
Not mentioned
WebEx, GoToWebinar
used within trust
Start pages /
portals
Not mentioned
Not mentioned
Accessible to users
- library has
several. Weebly
formerly blocked
12
Availability: social media
T1-DGH
T3-MH
T4-TH
Unable to access or create –
prevents library using for
current awareness purposes
Restrictions not mentioned
on general blogs
WordPress blogs formerly
(maybe still) blocked
Time quota set for use of
Twitter. Trust starting to use
for corporate
communications, but
individual use not
encouraged
Twitter, Facebook: users and
would-be bloggers should
seek advice from
Communications before
using professionally
Issuing of Twitter handles
required permission from
divisional director
Collaborative
projects
Social
networking
services
Restrictions not mentioned
Restrictions not mentioned
Restrictions not mentioned
Facebook: time quota set for
use
Originally blocked entirely
following breach of
confidentiality by clinical
staff member
LinkedIn and other
‘professional’ sites
accessible
Facebook blocked
Access to Facebook etc.
blocked on PCs but not on
users’ mobile devices – trust
has a BYOD network and
policy. Some staff approved to
use social media for work
purposes. LIS has Pinterest site
– infographics
Content
communities
Time quota set for use of
SlideShare
SlideShare not mentioned
Status of SlideShare unclear
Prezi formerly blocked as
presenting confidentiality
risks – now has time quota
set
Prezi - restrictions not
mentioned – IT manager
unsure of policy – Comms
provides training on Prezi
Prezi blocked
Time quota set for use of
YouTube
Specific permission required
to access YouTube - NB
bandwidth limitation
statement in place – 10s
pauses
YouTube reported by
pharmacist as blocked but this
denied by IT Manager
Blogs /
Microblogs
LinkedIn and other
‘professional’ sites
accessible
Twitter blocked by default
Classification:
Kaplan &
Haenlein (2010)
13
Perceived risks / reasons for non-use
• Breaches of privacy
• Sharing of images via smartphone and tablet cameras
• Breaches of confidentiality
• Patient information
• T1 – breach of confidentiality by clinician – led to clampdown
• Corporate information
• Failure to maintain appropriate professional
boundaries
• Patients, carers, students
• Affecting reputation
• Employing organisation, profession, individual / career
• Time-wasting / trivial / unproductive
• Lack of time
• Lack of encouragement, training and guidance
14
Perceived benefits / existing uses
• Staff, patient, public engagement
• Professional networking and discussions
• e.g. LinkedIn, Doctors.net.uk, Sermo, #WeCommunities on Twitter
• Research dissemination / current awareness
• Library portals / RSS feeds, Twitter
• Teaching
• Podcasts, YouTube videos
• Information sharing and collaboration
• File storage and sharing applications e.g. Dropbox
• Content communities e.g. Mendeley, SlideShare, Prezi
• Teaching / learning administration
• e.g. Facebook
15
General findings
• Often perceived as high-risk – especially by nurses – privacy and confidentiality
concerns
• Sometimes felt to be suitable only for personal or recreational use
(cf. Ward et al., 2009)
• Professional online forums favoured by AHPs – e.g. iCSP
• Big generational differences in use and expectations
• Gradual process of acceptance:
• external drivers e.g. NHS Employers, professional bodies
• starts with corporate use – T1
• “gently washing in” – T3
• tool for patient / public / staff engagement
• availability of policies and guidance, e.g. NMC, GMC, HCPC, BASW
• training in “e-professionalism”
• BYOD a facilitator – T4 – relates to mobile device use
• Educational usefulness of YouTube content increasingly recognised
by IT departments
16
Theoretical perspectives - 1
Chretien and Kind (2014) – hierarchy of needs (after Maslow)
17
Theoretical perspectives - 1
Chretien and Kind (2014)
• Possible explanation – process analogous to
Maslow’s hierarchy of needs
• More basic levels of needs must be met before higher,
aspirational levels can be fully attained
• Three levels: security, reflection, and discovery
• Reflection and discovery can start to take place once
security is established
• Organisation-wide
• Professional groups
• Individual clinician
18
Theoretical perspectives - 2
• Vaast and Kaganer (Kaganer & Vaast, 2010; Vaast & Kaganer, 2013)
• Focus: emerging social representations of social media
use held by organisational decision makers
• 25 private sector social media policies
• Innovation theory
• Theory of IT-culture conflict (Koch, Leidner & Gonzalez, 2013)
• Social representations framework
• Anchoring - incorporating the understanding of new phenomena
within existing social representations
• Objectification - process of forming new meanings of the
phenomena
19
Theoretical perspectives - 2
Traditional IT decision-making
User-driven technologies
• Develop shared
• Develop shared
understanding
• Create organising vision
for local innovation
• Generate local social
representation
• Yes / no?
understanding
• Decide how to respond on
behalf of organisation
• Develop ways to guide /
direct end-users
• If yes, facilitate end-users’
adoption and learning
processes
• What may / may not do with
the technology
• Whether (and if so, how) to
adopt the technology officially
Questions?
Catherine Ebenezer
[email protected]
http://www.mendeley.com/profiles/catherine-ebenezer1/
@ebenezer1954
20
References
• Blenkinsopp, J. (2008). Bookmarks: web blocking – giving Big Brother a run for his
money. He@lth Information on the Internet, (62), 2008.
• Bradley, P. (2012). Why librarians must use social media. At
http://www.slideshare.net/Philbradley/why-librarians-must-use-social-media
[accessed 23/01/2015]
• Cain, J. (2011). Social media in health care: the case for organizational policy and
employee education. American Journal of Health-System Pharmacy 68, 1036-1040.
• Chretien, K., & Kind, T. (2014). Climbing social media in medicine’s hierarchy of
needs. Academic Medicine, 89(10), 1318–1320.
• Eysenbach, G. (2008). Medicine 2.0: social networking, collaboration, participation,
apomediation, and openness. Journal of Medical Internet Research 10(3), e22.
• Hamm, M. P., Chisholm, A., Shulhan, J., Milne, A., Scott, S. D., Klassen, T. P., &
Hartling, L. (2013). Social media use by health care professionals
and trainees: a scoping review. Academic Medicine : Journal of the
Association of American Medical Colleges, 88(9), 1376–83.
21
22
References
• Hughes, B., Joshi, I., & Wareham, J. (2008). Health 2.0 and Medicine 2.0: tensions and
•
•
•
•
•
controversies in the field. Journal of Medical Internet Research, 10(3), e23.
Hughes, B., Joshi, I., Lemonde, H., & Wareham, J. (2009). Junior physician’s [sic] use
of Web 2.0 for information seeking and medical education: a qualitative study.
International Journal of Medical Informatics, 78(10), 645–55.
Kaplan, A. M. & Haenlein, M. (2010). Users of the world, unite! The challenges and
opportunities of social media. Business Horizons 53(1), 59-68.
Kaganer, E. & Vaast, E. (2010). Responding to the (almost) unknown: social
representations and corporate policies of social media. ICIS 2010 Proceedings. At
http://aisel.aisnet.org/icis2010_submissions
Koch, H., Leidner, D. E., & Gonzalez, E. S. (2013). Digitally enabling social networks:
resolving IT-culture conflict. Information Systems Journal, 23(6), 501-523.
Lafferty, N. (2013). NHS-HE connectivity project: Web 2.0 and social media in
education and research. Retrieved from
https://community.ja.net/groups/search/NHS-HE%2520forum.
References
• NHS Employers (2013). HR and social media in the NHS. London: NHS
•
•
•
•
•
•
Employers. Retrieved from www.nhsemployers.org.
NHS Employers (2014). A social media toolkit for the NHS.
London: NHS Employers. Retrieved from www.nhsemployers.org.
Prince, N. J., Cass, H. D., & Klaber, R. E. (2010). Accessing e-learning and eresources. Medical Education, 44 436-437.
Renaud, K., & Goucher, W. (2012). Health service employees and information
security policies : an uneasy partnership? Information Management and Computer
Security, 20(4), 296–311.
Technical Design Authority Group (2008). TDAG survey of access to electronic
resources in healthcare libraries. London: TDAG.
Vaast, E. & Kaganer, E. (2013). Social media affordances and governance in the
workplace: An examination of organizational policies. Journal of ComputerMediated Communication 19(1) 78-101
Ward, R., Moule, P., & Lockyer, L. (2009). Adoption of Web 2.0 technologies in
education for health professionals in the UK: where are we and why? Electronic
Journal of e-Learning 7(2) 165-172. Retrieved from www.ejel.org.
23